Preventative Teeth Cleaning & Oral Agreement Form

Client Name:

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Patient:

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Preventative Teeth Cleaning and Oral Assessment(PTCA)

The non-anesthetic procedure performed on your pet today is considered to be an Oral Hygiene procedure, and is not recognized to be a complete Dental Prophylaxis as determined by the American Veterinary Medical Association. A complete dental prophylaxis consists of radiographs of the roots of the teeth, and an extensive cleaning comprised of sub-gingival scraping and examination, as well as scaling and polishing of the teeth. This is performed under general anesthesia and will require full blood panels. The Veterinary Oral Health Counsel recommends an anesthetic procedure yearly, for most pets.

Initials:

The procedure performed today is designed to be used for routine minor teeth cleaning in an effort to prevent major dental disease from starting and progressing. It also may be used on animals that have advanced heart and kidney disease that are too compromised for general anesthesia. The client is aware that the procedure in these cases is less than optimal. Veterinarians at Mountain View Animal Hospital will make recommendations if the examination reveals problems that require a complete dental prophylaxis.

Initials:

Risks of this procedure may include soreness of the gums, respiratory infections or unidentified tooth root disease that is only visible with radiography (X-Rays). Please contact us immediately if you notice lethargy, coughing, decreased appetite or a painful mouth in the future.

Initials:

In addition, the Nevada State Veterinary Board of Medical Examiners requires a current patient/client/doctor relationship (complete annual examination) with a Mountain View Animal Hospital (MVAH) Veterinarian when any procedure occurs at our hospital, including a preventative teeth cleaning. Thank you for your understanding.

Initials:

By signing this document, you are stating that you understand the difference between a complete dental prophylaxis and the oral hygiene procedure you have elected to have done today, in addition to the benefits and risks of the procedure and current Nevada State Laws.

Thank you for allowing Mountain View Animal Hospital and Holistic Pet Care to be a part of your pet’s health care.